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. <br /> , FOIt CITY USE ONLYr - <br /> /���0� City of Orono Date Received: �/!o Pernrit# � �s� <br /> r i P.O.Box 66 <br /> � 2750 Kelley Parkway ❑In-House SAC Determina6on Form Completed <br /> �s� �-f Crystal Bay,MN 55323 <br /> \\,�A c s�i�4�.�� (952)249-4600/F�(952)249-4616 Approved By(I�'Required): �� U J <br /> CITY OF ORONO-SEWER& WATER/GENERAL PERMIT <br /> (*Note:Some permits may require approvai by the Buiiding Official and/or Public Works Departrnent•) <br /> (ALL PERMIT'S- Mav be subiect to further review and mav not be issued whea the anulication is receivedl <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applicarions are subject to the postage and handling fee shown below. Pernvt cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Urility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANI'MAIN without express <br /> approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That A 1 <br /> �Residential(May Require Approval) ❑ Commercial(Approval Required) <br /> ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �Disco�ect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner info�afion: <br /> Site Address: 1 �.�.L (�,;' c� , tc� �� �, ('e� � �- �'� t� <br /> Owner: �'u �F '�4����t�,Fc��a MailingAddress: �� r, �r��►���.�1-�, ��,;�� Rp <br /> City: �`l C-'�`� � �} Zip: ��3"�� <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: C T�� S c� ,,,;�� �,,,�,,��� Contact Person: �` ����-� <br /> Address: ���� o.��,,� ��;,,� State License #: � ")��q • ,�.�� <br /> City: 1�lv;�e��c� Zip�� Expiration Date: \�, - 3\� \(� <br /> Phone: �\a-S G�-`1"1�`� Alternate Phone: <br />